Demirli Atici S, Canda AE, Terzi MC. Local excision in rectal cancer: When and for whom? World J Gastrointest Oncol 2025; 17(9): 106146 [DOI: 10.4251/wjgo.v17.i9.106146]
Corresponding Author of This Article
Semra Demirli Atici, Department of General Surgery, Acibadem Kent Hospital, 8229/1. Sk. No. 56, 35620 Çiğli, Izmir 35620, Türkiye. smrdemirli@hotmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Sep 15, 2025; 17(9): 106146 Published online Sep 15, 2025. doi: 10.4251/wjgo.v17.i9.106146
Local excision in rectal cancer: When and for whom?
Semra Demirli Atici, Aras Emre Canda, Mustafa Cem Terzi
Semra Demirli Atici, Aras Emre Canda, Mustafa Cem Terzi, Department of General Surgery, Acibadem Kent Hospital, Izmir 35620, Türkiye
Semra Demirli Atici, Aras Emre Canda, Mustafa Cem Terzi, KRC Clinic for Colorectal Surgery and Peritoneal Surface Malignancies, Izmir 35220, Türkiye
Author contributions: Demirli Atici S, Canda AE and Terzi MC wrote the manuscript; Canda AE and Terzi MC reviewed and supervised the manuscript preparation; All authors read and agreed to the published version of the manuscript.
Conflict-of-interest statement: The author(s) declare having no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Semra Demirli Atici, Department of General Surgery, Acibadem Kent Hospital, 8229/1. Sk. No. 56, 35620 Çiğli, Izmir 35620, Türkiye. smrdemirli@hotmail.com
Received: February 17, 2025 Revised: April 7, 2025 Accepted: April 17, 2025 Published online: September 15, 2025 Processing time: 210 Days and 9.6 Hours
Abstract
Local excision (LE) is an effective treatment option for rectal cancer that shows significant regression following neoadjuvant chemoradiotherapy. Compared to traditional total mesorectal excision (TME), LE can achieve comparable oncological outcomes while preserving function and improving quality of life (QoL). The indications for LE have been gradually expanded, but there are uncertainties regarding postoperative oncological results. Long-term follow-up prospective randomized controlled trials comparing TME and LE in terms of both oncological outcomes and QoL could help reduce uncertainties between these two approaches and contribute to the development of evidence-based guidelines for rectal cancer treatment.
Core Tip: Local excision (LE) may be considered for rectal cancer patients who exhibit significant tumor regression following neoadjuvant chemoradiotherapy. LE, which includes transanal endoscopic microsurgery and transanal minimally invasive surgery, is a feasible and effective surgical method that can achieve oncological results similar to those of total mesorectal excision but causes relatively less functional loss, shorter hospital stays, less blood loss, and improved quality of life. It is important to carefully select suitable patients for LE, but its indications are gradually expanding with studies in the literature. However, inadequate guidelines, lack of information about postoperative oncological outcomes and appropriate patient selection, and preoperative staging play an important role in creating a treatment plan for rectal cancer.
